What are the current best practices for managing Alcohol Use Disorder (AUD) and achieving sobriety?

From the Guidelines

The most effective approach to managing Alcohol Use Disorder (AUD) and achieving sobriety is to develop a comprehensive plan that includes medical support, behavioral strategies, and social reinforcement, with a focus on total alcohol abstinence, as recommended by the most recent guidelines 1. To start, it's essential to consult a healthcare provider who can assess drinking patterns and recommend appropriate treatment options.

Key Components of a Comprehensive Plan

• Medical support: Medications such as naltrexone (50mg daily), acamprosate (666mg three times daily), and disulfiram (250-500mg daily) can help reduce alcohol cravings and manage withdrawal symptoms, as noted in earlier studies 1.
• Behavioral strategies: Counseling or therapy, such as brief motivational interventions, can help individuals develop coping mechanisms and achieve sobriety, as recommended by earlier guidelines 1.
• Social reinforcement: Joining support groups like Alcoholics Anonymous or SMART Recovery can provide community support and practical strategies for maintaining sobriety.

Managing Withdrawal Symptoms

For individuals experiencing alcohol withdrawal syndrome (AWS), benzodiazepines are considered the 'gold standard' treatment, given their efficacy in reducing withdrawal symptoms and the risk of seizures and/or delirium tremens, as stated in recent guidelines 1.

Additional Considerations

• Set clear, achievable goals—whether complete abstinence or reduced consumption—and identify specific triggers that lead to drinking.
• Stay hydrated, maintain proper nutrition, and establish healthy sleep patterns to manage withdrawal symptoms.
• Regular exercise and mindfulness practices can help manage stress and cravings.
• Remember that recovery is often not linear, and relapses should be viewed as learning opportunities rather than failures, as emphasized in recent studies 1. By prioritizing total alcohol abstinence and incorporating these components into a comprehensive plan, individuals can increase their chances of achieving and maintaining sobriety, ultimately improving their morbidity, mortality, and quality of life.

From the FDA Drug Label

Disulfiram is an aid in the management of selected chronic alcohol patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage. When used alone, without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic. Acamprosate calcium delayed-release tablets proved superior to placebo in maintaining abstinence, as indicated by a greater percentage of subjects being assessed as continuously abstinent throughout treatment Acamprosate calcium delayed-release tablets have been shown to help maintain abstinence only when used as a part of a treatment program that includes counseling and support.

The current best practices for managing Alcohol Use Disorder (AUD) and achieving sobriety involve a combination of:

• Medications: such as disulfiram and acamprosate, which can aid in the management of AUD and help maintain abstinence.
• Supportive therapy: including counseling and psychotherapeutic treatment, which is essential for the effective management of AUD.
• Motivation: patients must be motivated to remain in a state of enforced sobriety for treatment to be effective. It is essential to note that medications alone are not enough to manage AUD, and a comprehensive treatment program that includes counseling and support is necessary for achieving and maintaining sobriety 2 3.

From the Research

Current Best Practices for Managing Alcohol Use Disorder (AUD)

The current best practices for managing AUD and achieving sobriety involve a combination of medications, psychosocial interventions, and supportive care.

• Medications such as acamprosate, naltrexone, and disulfiram are approved by the U.S. Food and Drug Administration to treat AUD 4, 5, 6.
• Acamprosate and naltrexone have been shown to reduce alcohol consumption and increase abstinence rates, although the effects appear to be modest 4, 5, 6.
• Disulfiram has been used for years, but evidence supporting its effectiveness is inconsistent 4, 5, 6.
• Other medications such as topiramate, gabapentin, and ondansetron may be beneficial in reducing heavy alcohol use, but further study is needed 4, 7, 6, 8.

Psychosocial Interventions

Psychosocial interventions, such as cognitive behavior therapy and motivational interviewing, are effective in reducing alcohol consumption and improving abstinence rates 5.

• Cognitive behavior therapy should be a first-line psychosocial intervention for alcohol dependence, and its clinical benefit is enhanced when combined with pharmacotherapy or an additional psychosocial intervention 5.
• Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence 5.
• Residential rehabilitation may be beneficial for patients with moderate-to-severe alcohol dependence who require a structured residential treatment setting 5.

Supportive Care

Supportive care, such as peer support programs and aftercare, is essential for maintaining abstinence and reducing relapse rates 5.

• Peer-led support programs, such as Alcoholics Anonymous and SMART Recovery, are effective at maintaining abstinence or reductions in drinking 5.
• Aftercare should focus on addressing factors that contribute to relapse, and a harm-minimization approach should be considered for patients who are unable to reduce their drinking 5.

Special Populations

Special populations, such as pregnant and breastfeeding women, young people, and older adults, require tailored approaches to managing AUD 5.

• Pregnant and breastfeeding women should be advised that there is no safe level of alcohol consumption, and those who are alcohol-dependent should be admitted to hospital for treatment 5.
• Young people should undergo a comprehensive assessment, and treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks 5.
• Older adults should be screened for harmful alcohol use, and consideration should be given to alcohol as a possible cause for unexplained physical or psychological symptoms 5.